Tracheal instrument



W. 'F. BREHM I TRACHEAL INSTRUMENT April 23, 1940.

Filed March 23, 1939 v Patented Apr. 23, 1940 r 4 UNITED STATES PATENT OFFICE TRACHEAL INSTRUMENT William F. Brehm, Rochester, Pa. Application March 23, 1939, Serial No. 263,699

11 Claims.

My invention relates to tracheal instruments or appliances; devices, that is to say, which are adapted to assist in respiration, or speech, or both respiration and speech.

. spiration is made possible.

Ordinarily, in casesof this kind an instrument known as a tracheal tube is introduced through.

the incision into the trachea, to facilitate the passage of air duringbreathing. In some cases the patient is able to exhale through the throat and nasal passages, and in such cases it is customary to provide at the outer end of the tube a valve which, standing in open position during inhalation, moves into closed position during exhalation. When the tube is thus closed to outward flow, the air exhaled from the lungs passes upward, between the wall of the trachea and the tube, into the throat and nasal passages. Thus it is that, during respiration, inhaled air enters through the instrument, and exhaled air exits throughthe natural throat and nasal passages, permitting the patient to speak at will. This assumes, of course, that the patients larynx has not been removed and remains effective for the production of sound. r It has been found that a tube so arranged in the trachea substantially increases the resistance to air flow during exhalation, with the consequence and efiect that respiration becomes laborious. Indeed, some patients have complained that this increased resistance to exhalation produces muscular exhaustion and conditions of painful irritation in the chest. An object of my invention is to obviate this objectionable circumstance.

More particularly, theinvention consists in a tracheal tube provided with an aerodynamically operated valve which, normally standing in open position, closes when the user speaks. Under normal conditions of respiration, when the flow of air is at relatively low velocity, the valve remains open, and the user inhales andv exhales through the tube. The physical effort required for such artificial respiration is no greater, and, indeed, may be less, than that expended by a perfectly normal person. When the used begins to speak and the exhaled air flows at relatively Persons suffering from goiter or other morbid high velocity, the valve closes; then and only then is the flow through the tube interrupted and the exhaled air diverted to the throat and nasal passages of the user. As in the course of respiration the user inhales, the valve immediately reopens, and remains in open position until air is again exhaled at speaking intensity. By virtue of such improvement in tracheal instruments, the above-mentioned objection is eliminated.

The invention embraces other refinements and elaborations.

In certain cases the larynx of the afflicted person is removed, or is so far affected, that natural speech is impossible. Artificial larynges have been provided, and through the use of such devices speaking has been made possible. So far as I am aware, most, if not all, of the artificial larynx structures hitherto known have consisted in a sound-producing device that is externally connected to the tracheal tube, by means of a length of rubber tubing, or other flexible conduit. A tubular bit is provided on such sound-producing device, and the user, desiring to speak, inserts the bit in his mouth and exhales through the instrument. This flow of air, atspeaking intensity, actuates the sound-producing device, and the sound thus generated becomes efiectivein vowel chamber of the mouth and enables the user to speak. While artificial larynges of this sort have proved of great value to persons who otherwise would be mute, I have found need for improvement. Specifically, the instruments are too large and heavy; they are unsightly, and cumbersome to manipulate.

In accordance with the invention, I provide an artificial larynx which is light in weight and of compact construction, and which is arranged in particularly efiective organization within or at the outer end of the tracheal tube.

In the accompanying drawing I illustrate several embodiments of the invention. The instrument shown in Figs. I and II is primarily designed to assist breathing, and in exemplary way the tube portion of theinstrument is shown as a double tube, a tube within a tube, adapted to be inserted in the trachea; the outer end of the external tube is flared outward to shield the incision in the neck of the user, while the outer end of the inner tube is enlarged and equipped with a cover, to provide a housing for the valve alluded to in the introduction to the specification. Fig. I is a view of the instrument partly in side elevation and partly in section, and Fig. H is a fragmentary view, showing inelevation, and to larger scale, the enlarged mouth of the inner tube, with the cover thrown open.

Fig. III is a fragmentary view, partly in side elevation and partly in section, of a modified and elaborated form of the instrument, including structure by virtue of which the tracheal tube is serviceable as an artificial larynx; and Fig. IV is a view in end elevation of the enlarged end of the inner tube, with its cover removed and shown in plan from within. I

Fig. V is a view, comparable with Fig. III, illustrating certain modification in the structure and organization of the tracheal tube and artificial larynx; and Fig. VI is a fragmentary View of such assembly, as seen from the'right of Fig. V, with the cover removed from the end of the inner tube. Figs. III to VI are, "as'in"the 'cas'e'of Fig. II, shown on larger scale than that on which the instruments are actually built for service.

Referring to Fig. I of the drawing, the tracheal instrument or appliance consists in a tubular body'i terminatingat oneend'in-a headportion iii. In service'the tubular body is inserted in the tracheaof the user, with therhead portion I 0 pcsitioned over and closing theincision in the-users neck. The tubular body I is curved in itsextent, as shown, and includes an inner tube la snugly fitted within, but removable from, an outer tube l b. p The instrument is constructed-oinickel, or stainless steel, or silver, or a more noble metal, that-is resistant to corrosion and chemically'neutral to the moisture and glandular secretions present in .the human throat.

'I'he'outer end? of the inner tube ia is enlarged in diameterand provided with a hinged cover 2, forminga housing for a valve 4 which controls aport at in thehousing and adapts the instrument-to alternate conditions of service, as presentlywill'appear. The outer tube 11) terminates in a flange orbasalportion ie that serves basal. portion 'ic-of the-outer tube, may beused to-secure the instrument inposition of service, and additionally I-disclosein such patent how theotherwise-exposedendsof the twotubes may be screened .Within a cover, preferably an ornamental cover that blends artistically with the necklace oraband. While my present improve- I mentsare-notimmediately concerned with the invention claimed in the patent, I show in Fig. I a cover 5 which-:is arranged to screen the parts which, when the instrument is in place in a humanthroat, otherwise present an unpleasant appearance. The cover 5 may beplain, or it may be of ornamental filigree'design. .In this case I show the cover to be'hinged, as at 6, to the upper edge of the basal portion lo, and secured to the lower edge'of such basal sportion, by means of a'disengageable catch 1.

applied in Fig. II, and such body carries an integral sleeve portion 40. The mounting for the valve consists in a stem 9 borne rigidly by a supporting block l l on the wall of the housing. The stem 9 extends on the" axis of, and normal to the plane of, the orifice or port 30, and the valve 4, it isslidable on the stem 9 between the full-line position (Fig, II), in which. the port Si is open, and the broken-line position, in which the port is closed. It is to be further noted that the valve is arranged with its axis extending athwart the line of air flow from the tracheal tube; that is, the axis of the valve extends transversely to the outlet Id that opens from the tube la into the valve-housing 3. The conical side surface of the valve is exposed to the stream of air that, during exhalation, 'flows outward through the tube, and manifestly, under the influence of this exhaled stream of air, the valve tends to move from open to closed position. (The friction between the valve-and :the stem is utilized to oppose such tendency.) The weight-of the valve and the proportions of the parts are so determined that the valve (in open position) is unresponsive to the flow of air at normal breathing intensity; alternately, when air is exhaled at the higher-intensity incident to speaking, the valveis-immediateand tube l,jinto the trachea and lungs of the user. The valve continues in open position during normal conditions of respiration; that is, the valve remainsopen until .the useragain expels air atlspeaking intensity. Thus, advantages 0 the nature'indicated arerealized.

In case the afliicted person-fs larynx and the upper portion 1 of his trachea-are removed, or are so far affected thatno soundcanbe naturally produced, I provide in my instrument amartificial'larynx. The artificial-larynxis a sound producingtdevice; ordinarily, andas shown in this case, it'consists ina reed t2 adapted tobe vi br-ated b-ythestreamof ,air exhaledthrough the tube l at speaking intensity. ;Mcre;. specifically, the reed -l2 consists in=an elongate,:thin-leaf of resilient metal secured at one-end, by'means of rivets M to the wall portion 5300f the housing 317 at the outer-endof the tube I. (Note Figs. III

window l-3,:and' the reed .EQHQXTZQIIdS adjacent to andin approximate parallelismwith-such window. The form of the housing-3bvismodifiedas acomparison with-the structure-otFig. I and II will reveal, and the valve 4a is, conveniently,rarranged to move vertically rather than horizontally. Indeed, the ValVe lCL-iS trnodified in specific details of shape, but itis: operable-to-control the port 3%: in the sameageneraltinanner th-atthe valve 4 controls the port 30. Whereas in the structure first described, theastrearn of airdiverted by the closing :of --the valve 4, passes through an opening siin thetube l intothe upper tracheal of theuser, in the-structure-of Figs. III

.and IV, the stream of air at speaking intensity is diverted through the (sound-producing; device l2; l3) into a=flexible tube-15. Moreparticular- The wall. portion 3c\includes an open 1y, a cover It is secured over the reed assembly, and such cover includes a port or passage 8a. that communicates with the tube 15.

During normal conditions of respiration, the valve to. stands in open position, and air enters and leaves the instriunent by way of the port 3019. When the user desires to speak, he places the distal end ofthe tube l in hismouth and exhales air at speaking intensity. Immediately, the valve 4a is shifted into closed position; the exhaled stream. of air is diverted and flows through the window it, outlet 8a, and tube It into the vowel chamber of the users mouth. Such fiowof air through the window 83 causes the reed I2 to vibrate and produce sound, which is transmitted through the tube tothe users mouth. In known Way the user may speak.

While the valve la, the sound-producing device it, the cover it and the tube l5 are shown as parts assembled with the walls of chamber 3?) integral on the outer end of the inner tube la, it I is to be understood that these elements may be assembled in a unit that may be mounted on the outer end of the tube and removed at will, whereby the user may carry the unit hidden from view, say in his coat pocket, until such times as he desires to talk. I I

In Figs. V and VI, I show a structure in which the flexible tube 15 is eliminated, and the sound produced by the artificial larynx is carried into the mouth of the user through the upper portion of the users trachea. This structure is particularly serviceable in those cases in which, with the larynx removed or ineffective, the trachea still affords communication with the mouth. The principal modification in the structure consists in the provision of a double passage within the tracheal tube l, although it will be noted that certain other changes in detail are illustrated and perfectly intelligible in the drawing.

As shown. in Fig. V, the inner tube la. is tapered towards its outer end, in such mannerthat a secondary passage 80 is provided within the tube assembly. The housing 301 is integral with the inner tube la, and is horizontally partitioned, as indicated at 3e, providing two chambers a and b that severally communicate with the two passages within double tube I. A valve 4 is arranged in the chamber a to control the inlet and outlet port 3b, and a reed Hat is arranged before a port or window Ida which, together with the space 81) within cover lfia, establishes communication be tween the two chambers a and b. During normal respiration, the valve 4 stands in open position and air flows alternately in and out through the bore of the inner tube la and the port 30. When, from time to time, air at speaking intensity is exhaled through the tube, the valve 4 moves into port-closing position and the stream; of air is diverted through the sound-producing device l2a, 530., the passage 8b, the secondary chamber b, the secondary passage 8!), and the auxiliary or secondary outlet 8, into the upper trachea of the user. Such flow of air energizes the reed lZa, and the sound thereby produced is conducted through said course of flow into the vowel chamber of the users mouth. Thus, the user may speak. The artificial larynx is entirely enclosed within the confines of the relatively small housing 3d, and is adapted to be hidden from view within or below the collar of the users shirt or dress. Whether or not a cover, such as thecover 5 of Fig. I, be used is a matter of choice. Indeed, no such covers are shown for the structures of Fig. III to V1.

(Note Fig. IV.) I

I claim as my invention: 1. An instrument of the class described comprising a tube adapted to be inserted in the trachea of the user and provided at its outer end with a chamber, a port establishing communication between said tube and the outer atmosphere,

of said port in response to the flow of air through the tube atspeaking intensity.

3. In a tracheal tube including a port and a valve at one end; the refinement herein described in which said valve consists in an aerodynamically operated valve including a conical member ar-- ranged with its axis athwart theline of air flow from the mouth of said tube and movable under the influence of air pressure to and from portclosing position.

4. In an instrument of the class described including a tube adapted to be. inserted in the trachea of the user, a port providing an inlet and an outlet for air, a valve controlling such port, and an auxiliary port providing an outlet for air when the valve is in position ofclosure on the portfirst mentioned; the refinement herein described in which said valve is mounted for movement under inhalation from. position of closure on said port to open position and adapted to continue infopen position under normal conditions of respiration, said valve provided with a surface exposed to the stream of air exhaled through the tube and so arranged that the force of the stream tends to shift the valve from open to closed position, the parts being so proportioned that the stream flow of less intensity (incident to normal exhalation) is insufiicient and the stream flow of greater intensity (incident to speaking exhalation) is sufiicient to shift the valve into closed position and to divert the flow of exhaled air through said auxiliary port.

5. The structure of the next-preceding claim, together with a sound-producing element arranged in the line of flow to said auxiliary port.

6. An instrument of the class described including a chamber, a passage for establishing communication between said chamber and the trachea of the user, a port communicating with the outer atmosphere and providing an inlet and an outlet for said chamber, an aerodynamically operated valve adapted to close such port during speaking exhalation through said passage, and an auxiliary port for delivering exhaled air to the larynx of the user when the port first mentioned is closed by said valve.

'7. An instrument of the class described including a chamber, a passage for establishing communication between said chamber and the trachea of the user, a port communicating with the outer atmosphere and providing an inlet and an outlet for said chamber, an aerodynamically operated valve adapted to close such port during speaking exhalation through said passage, an auxiliary port providing for the delivery of a speaking stream of air when the port first mentioned is closed by said valve, and a wincbopen ated sound-producing devicearranged in the assembly in the line of flow between said passage and said auxiliary port.

8. In an instrument of the class described including a tube adapted to be inserted in the trachea of the user, a chamber provided at the outer end of said tube, a port establishing communication between such chamber and the outer atmosphere, and a valve controlling said port; the refinement herein described in which said tube is provided with two tracheal openings and includes two passages severally establishing communication between said openings and said chamber, said valve being mounted for movement under inhalation from position of closure on said portand adapted to continue in open position when, under normal conditions of respiration, the inhaled and exhaled streams of air flow through one of said passages, said valve being exposed to the stream of air exhaled through said last passage and so arranged and proportioned that a stream flow of speaking intensity shifts said valve into closed position, whereby said speaking flow of air is diverted to the second passage in said tube and'redelivered to the trachea of the user. j

9. In an instrument of the class described including a tube adapted to be inserted in thev trachea of the user, a chamber provided at the outer end of said tube, a port establishing communication between such chamber and theouter atmosphere, and a valve controlling said port; the refinement herein described in which said tube is provided with two tracheal openings and includes two passages severally establishing communication between said openings and said chamber, said valve being mounted formovement under inhalation from position of closure on said port and adapted to continue in open position when, under normal conditions of respiration, the inhaled and exhaled streams of air flow through'one of said passages, said valve being exposed to the stream of air exhaled through said last passage and so arranged and proportioned that a stream fiow of. speaking intensity shifts said valve into closed position, whereby said speaking flow of air is diverted to the second passage in said tube and redelivered to the trachea of the user, and a sound-producing device arranged in the line of flow or such diverted stream of air.

10. A tracheal tube including two outlet openings, and an aerodynamically operated valve arranged in cooperative relation with respect to one of said openings, said valve standing in one position with the flow of air in the tube at normalrespiration intensity and movable into alternate position when the flow of air rises to speaking intensity.

11. In a tracheal tube including an air passage and a valve mounted for movement between alternate passage-controlling positions; the refinement herein described in which said valve cornprises an aerodynamically operated valve ineluding a body resting in one of said positions when air flows through said tube at normal respiration intensity, said valve body having a surface extending angu'larly to the line of air flow, the flowing air (impringing on such surface) tending to shift said valve from such position of rest to its alternate position, the area of such surface being so proportioned that when the flow of air rises to speaking intensity the aerodynamic force acting on said area becomes eifective to shift the valve into its saidalternate position.

WILLIAM F. BREE-1M. 

